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Maternal perceptions of gastro-intestinal problems in the feeding of cowpeas (Vigna unguiculata) to young children in rural Ibadan, Nigeria
M. A. Hussain, I. O. Akinyele, and A. Omololu
A total of 880 questionnaires were completed and analysed to ascertain the perception of mothers as to the problems encountered by children consuming cowpeas. Over 90% of all mothers surveyed reported no problems attributable to the feeding of cowpeas. However, 9.9% (87) of the mothers reported that their children had problems after the consumption of cowpea foods.
Of all the mothers, 101 introduced cowpea foods for the first time at an age below six months, 470 between six and twelve months, 278 between one and two years, and 31 above two years. Of the 87 mothers reporting discomfort in their children, about 74.7 % (65) mentioned diarrhoea, 3.4% vomiting, 5.7% offensive stool, 1.2% abdominal pain, 6.9% bad breath, abdominal distension, and gas, and 1.2% both vomiting and diarrhoea. Only 18.4% of mothers of the affected children indicated that one or more of their children had stopped eating cowpeas. Problems with the consumption of cowpeas were reported to disappear later in life
The nutritional value of cowpeas lies in their high protein content, which is double that of cereals. The consumption of cowpeas is widespread in Nigeria either alone or in combination with cereals . Although such combinations may be too bulky to meet the protein and calorie needs of young children, a number of high quality protein recipes made from cowpeas that are suitable for young children have been described .
It has been amply demonstrated [3, 4] that legume intake results in flatulence because of the human lack of intestinal a -galactosidase enzyme to hydrolyse oligosaccharides to absorbable monosaccharides. When oligosaccharides escape digestion and absorption in the small intestine, they become exposed to colonic bacteria flora which ferment them, with gas production usually accompanying this fermentation. This may be a possible explanation for the abdominal distension, hence pain, as well as flatulence occurring in the reactor children. Though there is no documentation that this lack also results in diarrhoea, the sequence of digestion of legumes such as cowpeas could afford a suitable mechanism for the development of diarrhoea, particularly in poorly nourished children. Consumption by young children suffering from recurring bouts of intestinal infections exacerbates this problem. However, in populations habitually consuming legumes some type of adaptation may occur that lessens such undesirable gastro-intestinal effects .
It is possible that the problems encountered by children consuming cowpeas might discourage other mothers from using cowpeas in infant feeding. The overall effect of this would be to reduce the utilization of a crop resource that is widely cultivated. It might also prevent the development of new varieties capable of excellent economic returns. Consequently, it is desirable to establish the extent of these problems with cowpea foods in Nigeria. Thus a study to determine the perception of mothers on the incidence of the problems associated with cowpea consumption was carried out in the rural areas of Ibadan.
Methods and materials
Of 950 mothers interviewed in ten villages located in the Lagelu local government area of Ibadan. 880 completed questionnaires. Osegere village, which is about 25 kilometres from Ibadan, served as the fulcrum, and subjects were interviewed in villages in a clockwise fashion from Osegere.
Trained interviewers administered the pretested questionnaire to mothers of children between six months and two and a half years old. A reactor was defined as an individual whose mother claimed that he/she suffered from one or more of the afflictions of diarrhoea, vomiting, abdominal pain, abdominal distention, gas, or any other discomfort which the mother associated with the consumption of cowpeas.
The mothers interviewed were selected in each village using a table of random numbers, and the questionnaire was translated into the local language to facilitate the understanding of the questions by the villagers. Data from the questionnaire were tabulated into frequency tables, and the number of reactors within the population studied was estimated and expressed as percentages.
The results of the study are summarized in tables 1-4. These results show that over 90% of the mothers reported no problems attributable to the feeding of cowpeas to their children 6-30 months of age. However, 9.9% (87) mothers reported various complaints, including diarrhoea (74.7%), vomiting (3.4%), and a combination of vomiting and diarrhoea. Other symptoms reported were offensive stool (5.7%), abdominal pain (1.2%), and bad breath (69%).
About 71.3% of the mothers of the reactor group associated the discomfort with boiled cowpeas consumed with pepper and condiments; 12.6% attributed it to the consumption of boiled cowpeas alone, 5.7% to moinmoin (steamed cowpea paste with condiments and oil), 5.7% to other cowpea preparations, 2.3% to boiled dehulled cowpeas, and 2.3% to fried cowpeas (akara).
Of the 87 mothers who complained of intestinal discomforts in their children, 16 (18.4%) indicated that one or more of their children had stopped eating cowpeas. Fifty-seven mothers reported that the youngest child usually had problems with cowpeas, of whom 71.9% (41) mentioned diarrhoea, 8.8% vomiting, 3.5% each for abdominal distension and abdominal pain, and 8.8% offensive stool, while 3.5% complained of other problems in the youngest child (table 4).
A survey of the form in which the children were fed cowpeas showed that 89.3% (786) of the mothers fed cowpeas mixed with other items, while 10.6% (93) fed cowpeas alone. However, 90.X% (799) indicated that the mixtures caused no problem, while 3.9% (34) experienced discomforts even with mixtures.
About 59.7% (525) of the women gave boiled whole cowpeas to their children the first time, 14.8% (130) fed boiled dehulled cowpeas with pepper stew, and 4.9% (43) fed moinmoin, while 0.7% (5) fed akara and 0.2% (2) fed a mixture of two or more of the above.
TABLE 1. Responses to questions on the feeding of cowpeas to children
|How is your yougest child fed?|
|breast and bottle||163||18.5|
|breast and other foods||168||19.1|
|bottle and other foods||22||2.5|
|breast, bottle, and other foods||92||10.5|
|other foods only||383||43.5|
|At what age did you stop breast feeding your last child?|
|9- 12 months||54||6.1|
|At what age did you give cowpeas to your children for the first time?|
|How did you prepare the cowpeas you gave to your children for the first time?|
|boiled with the skin removed||130||14.8|
|boiled with pepper and condiments||174||19.7|
The fact that over 90% of mothers surveyed did not perceive any problems with cowpeas or their preparation is further evidence in support of the use of this resource in child feeding. especially for low-income families. The high nutritional value of cowpeas would ensure that infants and children consuming sufficient quantities would be able to meet their requirements for protein and some other nutrients.
TABLE 2. Responses to questions on problems associated with cowpeas
|How do you prepare cowpeas for your children?|
|boil and remove the skin||269||30.6|
|boil with pepper and|
|Do any of your children have problems in eating cowpeas?|
|If yes, what problems?|
|vomiting and diarrhoea||1||1.2|
|What type of cowpea preparation gave these problems?|
|boiled with the skin removed||2||2.3|
|boiled with pepper and condiments||62||71.3|
However, the survey also indicates the existence of undesirable symptoms associated with cowpea consumption in 9.9% of families sampled. Of the symptoms, diarrhoea, vomiting, and abdominal pains were the most recurrent and accounted for the majority of the adverse effects reported. Diarrhoea was the most important symptom responsible for the withdrawal of cowpeas from the child's diet.
The identification of diarrhoea, vomiting, abdominal pain, and gas as side effects of cowpea consumption is in agreement with the reports of other workers [3, 4, 6-8]. The persistence of the problems despite the prolonged cooking to which cowpeas are subjected during food preparation in Nigeria is difficult to explain. One possible contributing factor may be the coexistence of parasitic infection. Ascaris lumbricoides, a common intestinal parasitic infection of adults and children in the third world countries, reduces an antienzyme, polypeptide ascarase that neutralizes trypsin and chymotrypsin . The possible influence of an antienzyme secreted by ascaris in the gut of weanling children on tolerance of cowpeas should be investigated. It is probable that not all of the reported symptoms were due to cowpea consumption.
TABLE 3. Responses to questions on feeding cowpeas in a mixed diet
|Do you give your children cowpeas alone, or mixed with other foods?|
|Does the mixture cause any problems?|
|If yes, what problems? vomiting||3||8.8|
|Which is better: giving cowpeas alone, or mixed with other foods?|
The symptoms are similar to those produced in some individuals upon the ingestion of lactose as the result of a lactose intolerance problem arising from the low activity of the enzyme lactase (ß-galactosidase) . Whenever the lactose ingested exceeds the capacity of the intestinal lactase to digest it, it passes undigested into the large intestine, where it is fermented by the colonic flora, with short chain fatty acids and hydrogen gas as major products. The gas produced can cause abdominal distension and pain, and diarrhoea may also result from the fermentation products. It is probable that the diarrhoea occurring after eating cowpeas is due to increases in stool water content caused both by hyperosmolar effects of the products of fermentation in the colon and by the generation of water in the fermentation process .
Among individuals with incomplete lactose digestion, there is considerable variation in awareness of lactose intolerance and in the quantity of lactose that can be ingested without symptoms. Thus a certain level of lactose is tolerated without symptoms. When consumption exceeds the threshold level, intolerance symptoms become evident. Similarly. the quantity of cowpeas consumed at one time will be important in the extent of the symptoms encountered. The fact that some mothers claimed that the problem with cowpeas disappeared with age suggests that adaptation occurred. The quantity which will not cause discomfort should be determined by experience in feeding for each child.
TABLE 4. Responses to questions on the consumption of cowpeas for the first time and related effects
|Did any of your children have problems eating cowpeas the first time?|
|If yes, what age was the child when first given cowpea foods?|
|9- 12 months||16||18.4|
|Did any child stop eating cowpeas?|
|Does your youngest child have problems with cowpeas?|
|If yes, what are they?|
|Did any child have problems when given cowpeas at an early age which disappeared later?|
|What was the age of the child at which the problem was last noticed before it disappeared?|
Although only a small percentage of mothers reported that their children had problems attributable to cowpea consumption, the percentage becomes significant when converted to the actual number of Nigerian children who may be affected since these foods form an essential part of supplementary feeding during the weaning and post-weaning periods for infants and children in Nigeria.
The authors are grateful to the field assistants and all those who participated in the survey, to the Bean/ Cowpea Collaborative Research Support Programme for financial support, and to Ms. Y. F. Oyebamiji for typing the manuscript.
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